"Coral calcium" is a dietary supplement said to be derived from"remnants of living coral that have fallen from coral reefs, as aresult of waveaction or other natural processes." It is also said to be mined fromthe oldocean beds at the base of the coral reefs in Okinawa, Japan [1:120].Simplyput, "coral remnants" are limestone, which coral organisms originallymanufacture as a protective shell. Since coral reefs are protected bylaw, "coralcalcium" is made by grinding up limestone that no longer containslive organisms.

Limestone has no unique health properties. It is merely calciumcarbonate, with some magnesium and trace amounts of many otherminerals.Limestone fertilizer, available at garden centers, costs as little asa dollarfor an 80-pound bag. (Note: Limestone fertilizer is not suitable forhumanuse as calcium supplement. I mention it only to illustrate howinexpensivethe raw ingredients can be.) For people who need to consume extracalcium,purified calcium carbonate pills are safer and far less expensivethan "coralcalcium." But Robert R. Barefoot, of Wickenburg, Arizona, would likeyou to believe that limestone obtained from Okinawa provides "thescientificsecret of health and youth" and can cure cancer. His ideas have beenpromoted through books, lectures, his Web site, an audiotape, two 30-minute infomercials [2], interviews, and thousands of Web sites thatsell"coral calcium" products. Although his sales pitch is preposterous,he hasgained a wide audience. I have received more than 300 e-mailinquiriesstimulated by his infomercial, which is more than I have receivedabout any otherproduct. His book, The Calcium Factor [1], first published in 1992,hasundergone five editions and on January 31, 2003 enjoyed an AmazonBooks salesrank of #412, which is quite high. On the same day, his Death By Diet[3],originally published in 1996 and now in its fourth edition, was ranked#1790; and his other book, Barefoot on Coral Calcium [4], was ranked#8114.

Searching Google for "Robert Barefoot" yielded more than 31,000 hits,And searching for "coral calcium" found more than 80,000! In JanuaryandFebruary, Barefoot`s "A Closer Look" infomercial was among the mostfrequently shown infomercials and was the most frequent oneconnectedwith a dietary supplement. In March 2003, a newer infomercial versionhit #1on the frequency list and a Google Search for "coral calcium" topped120,000. Barefoot`s Cure America Web site listed his email address askingofcalcium@hotmail.com, which, considering his probable salesvolume is probably an apt description. In 2002, the U.S. FederalTradeCommission stopped the broadcasting of his infomercials but coralcalciumproducts are still widely marketed.

Dubious Claims

Here is a sampling of Barefoot`s claims followed by my comments inRed type. Except as noted, all are from his infomercial "A CloserLook."a.. "Over 200 degenerative diseases are caused by calciumdeficiency. That includes cancer, heart disease, diabetes,Alzheimer`s, you name it."These diseases are caused by acidosis -- acidification of the body --lackof minerals, especially calcium. When you start taking coral calcium,your body alkalizes and drives out the acid [5 ].All of these statements are incorrect. Calcium deficiency can weakenbones (osteoporosis), but it does not make the body more acidic orcause a wide range of diseases. The idea that calcium supplements (ordietary strategies) can change theacidity of the body is nonsense. The only acid level that diet orsupplementscan modify is the degree of acidity (pH) of the urine [6].

b.. "There are seven major cultures in the world that never, ever,ever get sick. They never get cancer, they never get heart disease,theynever get diabetes. They have no doctors. These people live 30, 40yearslonger, and they don`t grow old. What`s the common denominator? Onehundredtimes the RDA of everything. So they`re taking 100 times the RDA.They takeso much, they get all they need and the body passes what it doesn`tneed."[5]This statement is preposterous. There is no culture in which nobodygets sick. And nobody ingests 100 times the Recommended DietaryAllowancesof everything. That amount of iron, for example, would probably befatalwithin a few days.

c.. "The body can cure itself of all disease if given the nutrientsit needs." [1:142]Ninety percent of the disease in America can be wipedout if people get on appropriate nutrients.Not true. Although nutritional strategies can help prevent andmanage some diseases (most notably cardiovascular diseases), they arerarely curative. Moreover, thevast majority of diseases have little or nothing to do with nutrientlevels; and few diseases are treatable by administering dietarysupplements.

d.. Ninety-eight percent of people over age 60 are "totally calcium-deficient." That`s why we have all this trouble with heart disease,lupus, and Parkinson`s disease. Barefoot doesn`t say what "totallydeficient" means or where he gets this figure. However, U.S.government surveys indicate that at least half the people in this agegroup aregetting at least 900 mg per day, which would hardly makethem "totallydeficient."[7]Calcium`s relevance to high blood pressure may play a small roleIn theincidence of heart disease, but lupus and Parkinson`s diseaseare notcaused by calcium deficiency. Keep in mind that low calcium intakehas verylittle impact on calcium blood levels. Most of the body`s calcium isstoredin the bones, which can release whatever amounts are needed tomaintainadequate blood levels. Over a period of many years, this can produceosteoporosis, but it has little or no effect on other diseaseprocesses.

e.. Testing the pH level of the saliva is the most reliable test ofcalcium deficiency and can also tell the state of a person`s health.Testing saliva has no practical value in evaluating general health.The levelis usually similar to blood pH, which the body keeps within a narrowrange. When the saliva flow is high, the pH is usually about 7.4 (7isneutral, low numbers are acid, and higher numbers are alkaline).Calcium intakedoes not affect the pH of saliva. The most common cause of low (acid)salivarypH is the presence in the mouth of bacteria that cause cavities. Indiseases (such as diabetic acidosis) in which blood pH is dangerouslylow, the levelis determined by blood pH testing and calcium pills have no relevanceto treatment.

f.People should not be concerned about their cholesterol levelsbecause abnormal levels are not the cause of heart disease. The realproblemis calcium deficiency. Cholesterol problems will correct themselvesifyour minerals are balanced. (In another TV interview, Barefoot evenstates"Everyone blames cholesterol, but it absolutely has nothing to dowith heart disease."Hundreds of scientific studies support the medicalBelief that cholesterol is a major factor in cardiovascular disease.I amnot aware of any relationship between abnormal cholesterol levels andcalciumdeficiency; and Barefoot cites no evidence that supports what hesays.

g.. The two most important things people can do to be healthier,live longer, and disease-free are to take coral calcium and get aminimumof two hours of sunlight on their face every day -- withoutsunscreen.Barefoot presents no data to back either of these claims. Even worse,twohours a day of unprotected sun exposure -- particularly in warmclimates -- wouldplace the person at high risk of getting skin cancer.

h.. Experts quoted in the Journal of the American MedicalAssociation say that calcium can prevent and reverse colon cancer.Barefoot doesn`tcite the article, but I searched the journal site for "calcium"and "coloncancer" and found it. In 1998, researchers at the Strang CancerPreventionCenter and another prominent medical institution reported thatincreasingthe daily intake of calcium by up to 1,200 mg via low-fat dairy foodinsubjects at risk for colonic cancer reduced growth characteristicsthought to beassociated with the development of cancer [8].The study indicates that increased attention to calcium may find arole in cancer prevention, but the study had nothing to do witheither calcium supplements or the"reversal" of an established cancer.

i.. Barefoot claims to have seen "millions" of testimonials, had athousand people tell him how they cured their cancer, and witnessedpeoplewith multiple sclerosis "get out of wheelchairs just by getting onthe coral." He doesn`t say how he could possibly have received andreadmillions of testimonials, investigated a thousand cases of allegedcancercures, or determined that patients with multiple sclerosis wereactually helpedby coral calcium. Proper evaluation of claimed cancer cures wouldrequire(a)checking whether the patient had a biopsy,(b) checking whether or not the patient had standard treatment,(c) checking whether the patient was actually cancer-free,(d) following the patient`s course for severalyears,(e) and compiling detailed statistics.Do you think that Barefoot has done any of these things? The CalciumFactor contains seven brief testimonials from cancer patients, butnone contains enough detail either toIdentify any of the people or to evaluate what they report. Multiplesclerosistestimonials are even more difficult to verify because the diseasenormally has ups and downs. Controlled studies are needed todetermine whethera method is effective.

j.. All cultures in which people live very long, all the peopleconsume100,000 milligrams of calcium.That would be enough to cause kidney stones,calcium depositsthroughout the body, and death within a short period of time [9]. TheInstitute of Medicine recommends taking no more than 2,500 milligramsa day [7]. Taking twice that amount would be risky [9].Taking 40 times that amount would be insane.

k.. The Calcium Factor contains hundreds of scientific referencesthat back up what it says.If it does, they are well hidden. I found fewer than100 citations,many of which were to magazine articles and quaky books.The normal way to report journal references is to list the author,journal, volume, page numbers, and year of publication. Although Ilookedcarefully, I only found a few that were specified in this way, andsome werewritten by authors I know to be untrustworthy. A few passages gaveenoughinformation to locate the article to which they referred, and somepassages citedstandard medical textbooks. However, many of these were outdated,some were quoted out of context, and none appears to support any oftheclaims I have challenged in this article.

l.. About 600 years ago, people in Okinawa began putting coralcalcium in their food and discovered that they gradually gothealthier. About100 years later, Spanish explorers came and found virtually nodisease. So theyfilled up their shipholds and brought it to Spain, where theyanalyzed itand found not only calcium but a perfect balance of magnesium and 70othertrace metals and other minerals.That`s an amazing story, considering the fact that 500 years ago thenature and existence of trace minerals was unknown.

m.. Okinawans do not get cancer.This is easy to explode by doing a Medline search for articles aboutcancer that mention Okinawa in their title. I found at least ten thatdescribe the incidence of variouscancers.

n.. The calcium in coral calcium is far more absorbable (100%) thanthe calcium in milk (17%) , calcium citrate products (10%) and antacidproducts(1-2%).Experts interviewed by the Washington Post state that purecalcium carbonate products are 30-35% absorbable [10].In 2003, a newer Barefoot/Trudeau infomercial ("The Debbie & KevinShow") highlighted and misrepresented the JAMA calcium study andclaimedthat coral calcium had cured many cases of terminal cancer.Barefoot`s ideas and various coral calcium products have also beenpromoted by several multilevel companies, one of which, in 1999, wasorderedby the FDA to stop making health claims that related its products tobloodpressure, arthritic conditions, heart disease, or digestive reflux[11].

Other regulatory actions are listed below.

Questionable Credentials

Thousands of Web sites refer to Barefoot as "Dr. Robert Barefoot" orRobert Barefoot, Ph.D. However, he is not a medical doctor and doesnot haveA Ph.D. degree. In 1999, Barefoot was not permitted to testify as anexpert in a case in which the Maryland Attorney General stopped themarketingof T-Up (an aloe vera concentrate) and cesium chloride for thetreatment ofcancer and AIDS. The case was extremely serious because the regimenhadkilled several of its users. During hearings in the case, thedefendantssought to have Barefoot testify that cesium was effective. Thecurriculum vitaethat Barefoot submitted described his formal education after highschoolas "1964 Northern Alberta Institute of Technology, Chemistry"and "1967Graduated with Honors, Chemical Research Technology." [12]This means that his highest educational credential is a diploma (nota university degree) that reflects only three years of coursework.The presiding Administrative LawJudge noted that Barefoot had formal training and experience ininorganicchemistry but had not had any professionally supported or supervisedtraining ordone any professionally recognized research in organic chemistry andbiochemistry in the human body. Although Barefoot described havingmany discussionswith doctors and patients about using cesium for treating cancer, thejudge concluded that "this experience and study was not scientific."In2000, a civil court judge ordered the defendants to pay millions ofdollarsin restitution and $3.7 million in civil penalties [13,14]. In 2001,theMaryland Court of Special Appeals upheld this decision in a rulingthat explained why Barefoot`s exclusion had been justified [15]. Oneofthe defendants received a 46-month prison sentence in a parallelcriminalcase [16].

Web sites also describe Barefoot as a "world-renowned chemist." Hiscurriculum vitae states that between 1968 and 1972 he published sixscientific research papers on analytical chemistry and diagenesis.Diagenesis refers to the changes that occur in sediments as they areburied under other sediments. This appears to have some relevance totheformation of limestone, but it certainly has nothing to do with humanbiologyor human health. Searching Medline, which is the most comprehensivedatabaseof medically-related journals, I located no articles with Barefootlisted as author. His curriculum vitae states that he has patented anore-extraction process and headed two companies that serviced thepetroleumindustry. His marketing activities have attracted considerableattention, but Idoubt that he deserves to be called a "renowned chemist."

Carl J. Reich, M.D., who co-authored The Calcium Factor, is aCanadian physician whose license was canceled in 1983. According toBarefoot,Reich had a thriving practice in Calgary, Canada, but the AlbertaCollegeOf Physicians and Surgeons considered his practices "potentiallydangerous." [2:92] The College`s public report states:A hearing was held before a panel of three peers on March 4, 1986.The allegations were:1.. Between the 3rd day of June, A.D., 1982 and the 3rd day ofDecember, A.D., 1982 provided treatment to patients contrary to theOrder ofThe Council of the College of Physicians and Surgeons of the ProvinceofAlberta dated the 3rd day of June, A.D. 1982.2.. Demonstrate a lack of skill and judgment in the practice ofmedicine in accordance with an assessment of his medical practice asconductedon December 13, 1983, by an Assessment Committee appointed by theCollege of Physicians and Surgeons of the Province of Alberta.On March 20, 1986 the Council of the College of Physicians andSurgeons of the Province of Alberta advised Dr. C.J. Reich that hisname was tobe struck from the Register of the College of Physicians and Surgeonsofthe Province of Alberta.Kevin Trudeau, who hosts Barefoot`s infomercials, has been the objectOf FTC regulatory action for false advertising. In 1998, inconnection withsix infomercials that he developed, Trudeau signed a consentagreement to(a) pay $500,000 in consumer redress,(b) be barred from making false claims for products in the future,and (c) establish a $500,000 escrow account or performance bond toassure compliance [17]. In the infomercials, Trudeau acts skepticalby questioning why listeners should believe variousclaims that the overwhelming majority of medical doctors woulddispute.Barefoot`s answer is simple (and incorrect). Doctors, he says, aretoo busy toread journals and get their information from drug companies; and drugcompanies don`t want them to know that coral calcium is moreeffective thantheir drugs. (Doctors actually get most of their information fromjournals,continuing education courses, and conversations with colleagues, notfrom drug companies.)

During the early 1990s, according to a report in the Wall StreetJournal, Trudeau served nearly two years in prison. In 1990, he pledguilty tolarceny in a Cambridge, Massachusetts, state court in connection with$80,000 in worthless checks he had deposited at a bank. Thesentencing memorandum said that he had posed as a doctor to increasehiscredibility with bank officials. In 1991, he pled guilty to credit-card fraud inBoston federal district court. Among his misdeeds in the federalcase, hemisappropriated for his own use the credit-card numbers of customersof the memory-improvement courses that he offered at the time [18].

The ostensible purpose of the infomercial is to sell The CalciumFactor and Death By Diet. The infomercial states that listeners canget aspecial price by calling a toll-free number. I assume that theproduct is notmentioned on the program because the cancer claim would make Barefootand Trudeausitting ducks for FDA prosecution. But by selling the book, they maybeprotected by freedom of the press as long as the contents of the bookareaccurately described. When I called the number to get the price ofthe books, Ilearned that the price was $37.97 plus $7.99 for shipping, a total of$45.96.The list prices on Amazon Books total $35.90, but buyers of both paynoshipping charge, and used and nearly new copies are available forless. I alsofound a coral calcium supplier who sells both books for $27.40postpaid.

Cost ConsiderationsThe monthly cost of coral calcium varies with the brand, pricecharged by the retailer, and the number of capsules taken per day.Barefootrecommends determining the daily dosage by testing the pH of yoursaliva (a testthat is not valid for determining calcium needs).The Calcium Factorstatesthat only 3 are needed for people in the "healthy range" but 6 or 9areneeded for people who are ill or are developing an illness [2:119].Sincemost people will test alkaline (7.2 to 7.4), the most likely dosagewouldbe 3 per day.During "A Closer Look," Trudeau states that callers to a toll-freenumber who mention the program`s name can take advantage of "specialarrangements" he makes with all of his program`s guests. When Icalled thetoll-free number, the operator answered "The Calcium Factor." When Iaskedwhether this was a regular business, he said that it was just anordercenter. When I asked who owned it, he first said he didn`t know andthen saidtheir names were "Tom" and "Steve." When I asked about the "specialarrangements,I was told that the books, three videotapes, and three audiotapeswereavailable free as part of a package that includes ten 90-capsulebottles of"Coral Calcium Daily" for $299.99 plus $19.98 shipping ($32 perbottle), andthat buyers of the package can get additional bottles for life forhalfthat much. The product contains calcium carbonate, 3 other minerals,andvitamins A, C, D, and E. The operator told me that the recommendeddosage is 3 capsules per day, which would make the monthly cost about$32 for thefirst ten months and about half that much thereafter. I don`t knowwhat`sspecial about the arrangement, but I found what looks like the samedeal on aWeb site for $50 less. Bob Barefoot`s Coral Calcium Supreme, theproductpromoted by the Debbie & Kevin infomercial, has a similar range ofprices.The "Barefoot Calcium Plus" formula, which appears to be a majorcompetitor, contains the same ingredients plus seven more minerals.The CoralCalcium Supplement Center sells twelve 90-capsule bottles for $263.40plus$17.70 for shipping, which would total about $23 per month. Neitherproductrationally formulated. Purified calcium carbonate tablets, whichshould be chewed to enhance absorption, can be obtained in drugstoresand otherretail outlets for about $2 per month. Vitamin D can be important,especially for people who have minimal exposure to sunlight. However,people whoneed supplementary vitamin D can get it combined with calciumcarbonate atno additional cost. The other nutrients in these products are readilyavailable in more complete multivitamin/multimineral products thatneed notcost more than $2 per month [19].

Safety Considerations

Using an inexpensive calcium supplement may also be safer. Laboratoryanalyses have shown that some calcium supplements contain significantamounts of lead and other heavy metals [20]. The UC Berkeley WellnessLetter has warned:There has been little or no good research on coral as a source ofcalciumor as a treatment for disease. But that doesn`t stop the marketersfrom making their claims, since dietary supplements are virtuallyunregulated.You have no idea what`s really in the bottle or if the stuff is safe.Historically, calcium supplements haven`t always been safe: years agocalcium carbonate from bone meal or oyster shells, for instance, wasused in some supplements -- but was later found to contain highlevels oflead. Since then the government and manufacturers took action toreducelead levels in existing calcium supplements. But new supplements cangountested [21].The Wellness Letter statement turned out to be prophetic. In June2003, ConsumerLab reported that Bob Barefoot`s Coral Calcium Supremecontains 2.5 micrograms of lead per gram of calcium [22]. This mightnot pose aphysical threat (except, perhaps, to a developing child when taken bya womanwho is pregnant or breastfeeding). However, there is no logicalreason takethe product when many other calcium supplements have a lower leadlevel.California requires that products exceeding the "no significant risklevel" of 1.5 micrograms of lead provide a warning label -- whichBarefoot`s product does not.

Government Action

The outrageous nature of Barefoot`s claims has triggered regulatoryaction here and abroad. In June 2003, the United Kingdom`sIndependentTelevision Commission (ITC) announced that it had levied a &#163;60,000fine on thetelevision shopping channel, Shop America (a subsidiary of TrustarGlobal Media) for several breaches of the ITC`s Advertising Code. Themainoffense was an ad which claimed that Bob Barefoot`s Coral CalciumSupremecould help reverse cancer and other serious diseases and couldbenefit everyone,including babies. The penalty also covered misleading ads for theFresh Start diet plan and a golfing product [23]. One week later, theU.S.Federal Trade Commission charged Barefoot, Trudeau, Shop America(USA), andDeonna Enterprises with making unsubstantiated claims that "go farbeyondexisting scientific evidence regarding the recognized health benefitsof coralcalcium." The FTC filed suit in Chicago federal court abd quicklyobtained a temporary restraining order and an asset freeze. Inaddition, theFTC and FDA sent warnings to many Web site operators who are makingsimilarclaims [24] and U.S. Marshals seized $2.6 million worth of CoralCalciumSupreme [25]. In a separate action, the FTC alleged that Trudeauviolated the 1998FTC order prohibiting him from making unsubstantiated claims about thebenefits, performance, or efficacy of any product. The FTC allegesthat Trudeauviolated the order by making false and unsubstantiated claims aboutCoral Calcium Supreme and Biotape (a purported pain-relief productwhichTrudeau promotes through a separate infomercial). In this action, theFTC isseeking a finding of contempt, monetary relief, and other injunctiverelief,as well as a temporary restraining order that would prohibit Trudeaufrommaking the challenged claims, and would freeze his assets [26].Biotape`sdeveloper, Darrell Stoddard, claims that pain is caused by blockageof "lifeforce" ("chi") and that the tape is conductive mylar that "connectsthebroken circuits." [26] Users are instructed place a strip of Biotapedirectly on the parts of their body where they feel pain.

In January 2004, shortly before a trial would otherwise taken place,the FTC announced that Barefoot had agreed to a permanent injunctionunderwhich he, Deonna Enterprises, Inc., and Karbo Enterprises, Inc., are:

a.. Prohibited from making unsubstantiated claims that:a.. "Coral Calcium Supreme" or any other coral calcium productcantreator cure cancer, multiple sclerosis, heart disease, high bloodpressure, and other serious diseases.b.. The body absorbs coral calcium better than other calciumsupplements in the market.c.. A daily serving size of such a product provides the sameamount of bioavailable calcium as two gallons of milk.d.. Scientific research published in JAMA and elsewhere provesthatcalcium supplements are able to reverse or cure cancer in thehumanbody.

b.. Prohibited from making unsubstantiated claims about the healthbenefits, performance, or efficacy for any dietary supplement, food,drug, cosmetic, device, or service.c.. Required to recall any product packaging that makes theprohibited claims,d.. Required to notify resellers and distributors about the FTCaction.The court order also permits the FTC to recover all royalties owed toBarefoot in connection with the Coral Calcium Supreme infomercialMarketing [27,28]

The Bottom Line

Calcium intake is an important factor in bone health and may playsome role in the prevention of colon cancer. Barefoot has embellishedthesesimple facts to create an elaborate scheme to promote hispublications andcoral calcium products. His current video is the most outrageousinfomercial I have ever seen. Your best bet is to completely ignorewhat he saysand follow a medically approved program that includes adequatecalciumand other measures for preventing osteoporosis. The National AcademyofSciences advises Americans and Canadians at risk for osteoporosis toconsumebetween 1,000 and 1,300 milligrams of calcium per day [7]. This canbe donewith dairy products, supplements, or both. Readily absorbablesupplementsneed not cost more than a few cents a day.Coral calcium products are a waste of money, and some areirrationally formulated. For professional advice on calcium intake,ask aregistered dietitian (R.D.) or physician to help you. Meanwhile, ifyou havepurchased a coral calcium product and would like to share yourfeelings aboutit with us, please send me an e-mail message.

For Additional Information

a.. Acid/Alkaline Theory of Disease is Nonsenseb.. Robert Barefoot`s Curriculum Vitaec.. Council for Responsible Nutrition complaint to the FDAd.. Investigative Report by Terry Dunklee.. Transcript of "A Closer Look"f.. Transcript of "The Debbie & Kevin Show"

Reader Comment

I`ve never taken coral calcium, but I am a geologist withExtensive experience with calcium carbonate in the various forms. WeshippedThousands of tons of 97-plus percent pure limestone (CaCO3) for useas a feedadditive for livestock and poultry at $0.0075 per pound. I would havegladlyfilled the capsules by hand at the price the coral calcium people get.High-quality feed additive grade limestone gets a high of $20/tonwhilepharmaceutical pure precipitated calcium carbonate is probably in the$100/tonprice. By my rough estimate, "coral calcium" gets around $128,000 perton.